Faber James E
Department of Cell Biology and Physiology, Curriculum in Neuroscience, McAllister Heart Institute, University of North Carolina, Chapel Hill, NC, USA.
J Cereb Blood Flow Metab. 2025 Feb 4:271678X251317880. doi: 10.1177/0271678X251317880.
It has been estimated that approximately two million neurons, sixteen billion synapses and twelve kilometers of axons are lost each minute following anterior large-vessel stroke. The level of collateral blood flow has become recognized as a primary determinant of the pace of this loss and an important factor in clinical decision-making. Many of the topics in this review cover recent developments that have not been reviewed elsewhere. These include that: the number and diameter of collaterals and collateral blood flow vary greatly in the brain and other tissues of healthy individuals; a large percentage of individuals are deficient in collaterals; the underlying mechanism arises primarily from naturally occurring polymorphisms in genes/genetic loci within the pathway that drives collateral formation during development; evidence indicates collateral abundance does not exhibit sexual dimorphism; and that collaterals-besides their function as endogenous bypass vessels-may have a physiological role in optimizing oxygen delivery. Animal and human studies in brain and other tissues, where available, are reviewed. Details of many of the studies are provided so that the strength of the findings and conclusions can be assessed without consulting the original literature. Key questions that remain unanswered and strategies to address them are also discussed.
据估计，在前循环大血管卒中后，每分钟大约有200万个神经元、160亿个突触和12公里长的轴突丧失。侧支血流水平已被公认为是这种丧失速度的主要决定因素，也是临床决策中的一个重要因素。本综述中的许多主题涵盖了其他地方尚未综述过的最新进展。这些进展包括：健康个体大脑和其他组织中的侧支数量、直径以及侧支血流差异很大；很大比例的个体存在侧支不足；潜在机制主要源于发育过程中驱动侧支形成的通路内基因/基因座的自然多态性；有证据表明侧支丰富度不存在性别差异；并且侧支除了作为内源性旁路血管发挥功能外，可能在优化氧气输送方面具有生理作用。本文对大脑和其他组织中可用的动物和人体研究进行了综述。提供了许多研究的详细信息，以便在不查阅原始文献的情况下评估研究结果和结论的力度。还讨论了尚未得到解答的关键问题以及解决这些问题的策略。
